Управление финансовой устойчивостью и рентабельностью предприятия

Целью статьи является изучение значения управления финансовой устойчивостью и рентабельностью предприятия в современных условиях хозяйствования

Primary Cutaneous Neuroendocrine Tumor of the Vulva: A Case Report

Primary cutaneous neuroendocrine tumors (CNET) are extremely rare. Only a few cases have been reported so far. CNET have an indolent clinical course and usually present as a single flesh-colored nodule with a predilection for the scalp and trunk in elderly patients. While primary CNET have characteristic histological and immunohistochemical features akin to other low-grade neuroendocrine tumors elsewhere in the body, diagnosing these tumors on skin biopsies can be challenging as they are particularly mistaken for other, more commonly diagnosed, entities. In the current report we present a unique case of primary CNET of the vulva. The clinical presentation will be discussed as well as the histopathologic and immunohistochemical features and most importantly the possible pitfalls in microscopic examination

Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity

OBJECTIVE: To assess the prevalence of infectious complications and the protective effect of prophylactic antibiotic treatment after diagnostic office hysteroscopy in asymptomatic, infertile patients with normal results from transvaginal sonography. DESIGN: Recording of infectious complications after routine hysteroscopy in the context of a randomized controlled trial; pseudorandomized, center-specific application of antibiotic prophylaxis. SETTING: Two tertiary infertility care units. PATIENT(S): Six hundred thirty-one unselected, asymptomatic, infertile women who underwent routine, diagnostic hysteroscopy prior to a first in vitro fertilization (IVF) or intracytoplasmic sperm injection treatment. INTERVENTION(S): Depending on the hospital and according to local protocols, hysteroscopy was performed with or without antibiotic prophylaxis. MAIN OUTCOME MEASURE(S): The prevalence of infectious complications after routine hysteroscopy. RESULT(S): Of the 631 women who underwent routine, diagnostic hysteroscopy, antibiotic prophylaxis was prescribed to 266 women, whereas 365 women underwent the procedure without prophylaxis. Only one infectious complication occurred (0.4%) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis. This complication was successfully treated with antibiotics on an outpatient basis. CONCLUSION(S): Considering the extremely low risk of infectious complications and the lack of evidence, suggesting a beneficial effect of antibiotic prophylaxis, its use for routine, diagnostic office hysteroscopy should not be recommended

Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment

The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management

Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment

The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%–21%) and overall death rate 2.7% (0%–10%). Three patients were alive with recurrent disease (2.7% and 0%–11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management

Improved preoperative risk stratification with CA-125 in low-grade endometrial cancer: a multicenter prospective cohort study

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Cost-effectiveness of hysteroscopy screening for infertile women

This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are neede

Improving Endometrial cancer assessment by combining the new techniqUe of GENomic profiling with surgical Extra uterIne disEase assessment (EUGENIE)

Background: The molecular classification of endometrial cancer revolutionized our knowledge of its biology but so far has not affected our surgical approach. The exact risk of extra-uterine metastasis and hence the type of surgical staging for each of the four molecular subgroups are currently unknown. Primary Objective: To determine the association between molecular classification and disease stage. Study Hypothesis: Each endometrial cancer molecular subgroup has a specific pattern of spread and this pattern of spread could guide the extent of surgical staging. Trial Design: Prospective, multicenter study Major Inclusion/Exclusion Criteria: Participants eligible for inclusion in this study must meet all the following criteria: women ≥18 years with primary endometrial cancer, any histology and stage. Primary Endpoint: Number and site of metastasis in each endometrial cancer molecular subgroup. Sample Size: 1000 patients will be enrolled. Estimated Dates for Completing Accrual and Presenting Results: The trial will last 6 years: 4 years of accrual, and 2 years of follow-up of all patients. Results on staging and oncological outcomes are expected in 2027 and 2029, respectively. Trial Registration: The study has been accepted by UZ Leuven Ethical Committee. Belg. Reg. nr: B3222022000997

Risk stratification of endometrial cancer patients: FIGO stage, biomarkers and molecular classification

Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives